Healthcare Provider Details

I. General information

NPI: 1124246483
Provider Name (Legal Business Name): SUSAN MELANIE KRUEGER L.AC., EAMP, L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W HILL ST
MONROE WA
98272-1460
US

IV. Provider business mailing address

19710 209TH AVE SE
MONROE WA
98272-9377
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-0243
  • Fax:
Mailing address:
  • Phone: 425-242-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00024037
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00024037
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60121088
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: